Health Core Servicing Consultant at Kaelo Engage

Job Description

The Kaelo Health Specialised Servicing Consultant is responsible for responding to complex queries, managing complaints, troubleshooting service problems and providing general information regarding our products. Manage our customer and provider experience with excellence and accuracy. As a Specialised Consultant you will be expected to perform using a variety of channels, including telephonic and correspondence as well be skilled on all Kaelo products. Management of the provider relationship from contracting , service level agreements, administration, and reporting.

KEY OUTCOMES

• Manage networks
• Rango appointment management and reporting on the Halo network
• Management of authorisations

• Grow and maintain network providers
• Maintain contact information and communicate and store according to the business rules and requirements
• Maintain on-boarding and off-boarding of health providers
• Maintain client information  
• Resolve network related escalations
• Ensure maintenance of SLA’s and correct escalation protocols are adhered too

Source and contact health providers
Report on networks and appointments
Weekly and monthly reporting , but not limited to this frequency
Negotiate annual tariffs

Manage incoming queries and outbound responses with:

• Members
• Service Providers
• Intermediaries
• Health Providers
• RAF (Road accident fund)requests manage relationship with third party stakeholder

Manage omni-channel responses (including telephonic and correspondence) 
Provide product specific information across full product suite

Assess and determine when there is an operational query and or complaint
Identify and escalate priority issues

Manage and resolve customer and health provider complaints
Complete administrative tasks 
Continuous improvement and quality assurance
Monitor and manage trends
Conduct root cause analyses

SPECIAL REQUIREMENTS
Ability to maintain confidentiality, problem solve, negotiate and communicate, attention to detail. Ability to handle stressful situations appropriately 

Qualifications

PERSON DETAILS: WORK EXPERIENCE
REQUIRED

• At least 3 years’ experience in the Medical Scheme or Healthcare Industry in a data administration role 
• Knowledge of customer service practices and principles
• Excellent listening, verbal and written communication skills 

PREFERRED
Proven work experience in the Healthcare administration or managed care environment

EDUCATION: QUALIFICATIONS: ACCREDITATIONS WITH PROFESSIONAL BODY
REQUIRED

• Grade 12 or equivalent NQF 4 certificate

PREFERRED

TECHNICAL SKILLS OR KNOWLEDGE
REQUIRED

• Computer Literacy – Microsoft Excel, Word and PowerPoint
• Strong phone, email (written) and inter-person communication skills
• Call centre systems and multi-tasking

PREFERRED

• Knowledge of Medical Scheme Industry

Additional Information

•       Accountability

•       Action orientated

•       Collaborative

•       Communication skills

•       Simple writing skills

•       Problem solving skills

•       Encourages engagement

•       Manages complexity

•       Resilient and adaptive

•       Purpose driven

•       Significance and values orientated